Sterilization of instruments is the first step in the operation. Instruments can be sterilized by boiling (main method), firing (flaming) and antiseptic solutions (chemical sterilization).
Before sterilization, the instruments are wiped, removing the petroleum jelly from them, and their serviceability is checked. After removing the lubricant, the injection needles are washed with ether or alcohol. Sophisticated instruments (scissors, needle holders, hemostatic tweezers) are sterilized half-open or disassembled. Cutting and piercing tools are wrapped with gauze to prevent bluntness.
Sterilization by boiling. To sterilize instruments, they use a simple sterilizer, for heating which they use any heat source (stove stove, gas stove, electric stove, etc.), or an electric one. In the absence of a sterilizer, use any enamelware with a lid.
The sterilizer is an oblong metal box with a lid and an insertable mesh with handles for which it is held by hooks when removing instruments from boiling water.
When working with electrical sterilizers, they monitor the health of the wires, plug and socket, and also prevent water from flowing into the heating element. The sterilizer is placed on the refractory material.
To sterilize instruments by boiling, the required amount of water is poured into the sterilizer and 0.25% sodium hydroxide or 2% sodium carbonate is added. These alkali solutions, precipitating calcium and magnesium carbonate salts, protect tools from rust. The solution is brought to a boil and after 3 - 5 minutes from the moment it boils, a mesh with instruments previously laid out on it is immersed in the sterilizer. The instrument should not be put into cold water, since the oxygen released when it is heated quickly oxidizes the metal.
Duration of instrument sterilization 15-20 minutes; the time is counted from the moment the solution boils after immersing the mesh with tools in it. After the specified period has expired, the mesh is removed from the sterilizer and, as soon as the water drains from the instruments, they are laid out on a sterile instrument table, basin, or left in the sterilizer, after having poured water out of it.
After the operation, the instruments are washed with a brush in running water, boiled in a 2% sodium bicarbonate solution, wiped off, lightly greased (only the lock) with vaseline oil and put into a tool cabinet. The duration of boiling instruments after aseptic operations is 15 minutes, and after purulent ones - 45 minutes. Instruments contaminated with anaerobic microbes (causative agents of gas gangrene, tetanus, necrobacillosis, etc.) are boiled with short breaks 2-3 times for 30 minutes.
Glass devices (syringes, beakers, test tubes, etc.) are sterilized separately from metal instruments in distilled, rain or boiled water without the addition of alkalis. Syringes must boil in disassembled form, as they can burst due to the difference in the coefficient of expansion when the glass cylinder and the metal piston are heated. Before boiling, the components of the syringe and other glass objects are preliminarily wrapped with gauze and immersed in still unheated water. Duration of sterilization of glass items 15 min. Janet's syringes can also be sterilized in an autoclave.
Rubber items are sterilized by boiling in distilled water for 30 minutes or in an autoclave.
Sterilization by firing. This method is usually used to sterilize large instruments and enamel dishes. Other instruments are rarely sterilized by firing, mainly in emergency operations when there is no time for boiling sterilization. The instruments are placed in an enamel bowl or sterilizer, poured over with a small amount (10 ml) of alcohol and evenly fired. Firing sterilization is not reliable enough. In addition, during firing, tools, especially cutting ones, are severely damaged.
Chemical sterilization. For chemical sterilization, instruments are immersed in one of the following antiseptic solutions: 1) Karetnikov's liquid (formalin - 20 g, carbolic acid - 3 g, sodium carbonate - 15 g, distilled water - 1000 ml) - for 30 minutes; 2) 3 - 5% solution of carbolic acid - for 30 or 60 minutes; 3) bactericide solution 1: 3000 - for 10 minutes; 4) 1% alcohol solution of brilliant green for 15 minutes; 5) 0.5% formalin alcohol solution; 6) furacilin solution 1: 5000.
Chemical sterilization of instruments is used in cases where for some reason it is not possible to boil them or if they deteriorate from boiling.
Optical instruments (cystoscopes, laryngoscopes, etc.) are sterilized by immersion in alcohol for 10 minutes, and then a solution of basic cyanide mercury (1: 1000) is transferred for 15 minutes. Eyepieces should not be immersed in chemical solutions; they are wiped with alcohol before use.
A technique for sterilizing instruments and dressings with ionizing radiation, which has a pronounced antimicrobial effect, is being developed and tested.

The need to sterilize a veterinary instrument is intuitively understandable - it is designed to prevent the penetration of microorganisms into the treated wound and, as a result, infection of the patient upon contact.

General information

In medical and veterinary practice, various types of sterilization are widely used, which are divided into:

• physical;
• chemical methods.

Classical representatives of the first group are such methods of heat sterilization as boiling, pasteurization, steam treatment under pressure, dry heat, ultrasonic and radiation sterilization.

With chemical methods, microorganisms are removed with various solutions: iodine, formalin, acids, etc.

Basic sterilization methods

The boiling method has been and remains the most widespread for a long time. Its essence lies in heating the instrument in a disinfection boiler in distilled water with 2% sodium bicarbonate solution. Boiling is used for processing metal containers and mild tools. Cutting products quickly deteriorate when boiled, which is why scalpels, scissors, etc. immersed in a boiler for about 2 minutes, then immersed in alcohol for several hours. Currently, sterilization by boiling in medicine is rarely used, since some microorganisms die only at temperatures of 150-200 degrees - when treated with steam or calcined in a dry-heat oven.

Special steam sterilizers of modern models are fully automated. This makes it possible to process each type of instrument (packed in special bixes) according to the program specified by the manufacturer, which guarantees a high degree of asepsis. In addition to the instrument, steam sterilizes reusable catheters, drains, gloves, underwear, etc. At the end of steam sterilization, bacteriological control of sterility is carried out using special indicators.

The use of steam during sterilization is a risk factor for burns, which electric dry ovens lack. Lack of moisture, besides, it is good to process the cutting tool without the risk of reducing its quality and service life. After laying the processed inventory for 10-15 minutes, it warms up to 140 degrees and then, if necessary, to 200 degrees. Drying ovens can be of various sizes and are located in the immediate vicinity of the operating room: the collection of the processed instrument is carried out exclusively in sterile clothing.

Gas sterilization is used to process polymer products and is based on the properties of ethylene oxide (and some other gases) to have a bactericidal effect on the instrument. The disadvantage is explosiveness (you have to add carbon dioxide to the composition) and a long time to wait until the gas completely leaves the internal structure.

Radiation sterilization is widely used in the treatment of sutures, disposable syringes, catheters, etc. Ionizing radiation completely removes microorganisms, which, in combination with subsequent sterile packaging, makes it possible to store the instruments and devices sterilized by the radiation method for long months and even years.

Each of us at least once in our life wondered about sterilization of an instrument for surgical manipulations. Even if you took an ordinary needle for picking out a splinter and pre-wiped it on the edge of a T-shirt (at best, with a cotton swab with alcohol). More severe survivors burn the tip of a knife over a flame in order to then cut an enemy bullet from their buttocks ...

In this publication, I want to tell you the main points of preparing a surgical instrument before using it. So, let's begin…

ATTENTION!

This text has been corrected with the help of my colleagues and due to many inaccuracies. For which many thanks to them. I should also ask readers for forgiveness for their mistakes. In my practice, methods are used that involve the use of ready-made solutions and special equipment (autoclaves and dry ovens). I tried to describe more ancient (and available) methods, relying on publicly available sources, therefore there are so many inaccuracies.
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I must say right away that sterilization is only one (final) part of the entire preparation of a surgical instrument. There are three such parts in total: disinfection, washing *, sterilization itself. I want to clarify right away. The difference between disinfection and sterilization is that disinfection involves the destruction of pathogenic microbes (those that cause disease), and sterilization is the destruction of absolutely everything. [ Disinfection - the destruction of all microorganisms. Sterilization - the destruction of all microorganisms and their spores]

* - modern surgery combines disinfection and washing into the general concept of "pre-sterilization preparation", but this applies only to terms ... the essence of this does not change

Disinfection.

A newly used instrument is contaminated with blood, pus and other body fluids. He is infected... It is very dangerous to carry out any manipulations with it - any accidental cut, puncture or just contact with damaged skin can lead to the fact that you will become infected with some kind of nasty. Therefore, immediately after the operation, the used instrument is immersed in a bath with a disinfectant. In this case, it must be completely immersed in the solution. Disinfectants are 3% chloramine solution (exposure 40-60 minutes) or 6% hydrogen peroxide solution (exposure 90 minutes) *. After disinfection, the instrument is rinsed with running water to remove the disinfectant. The procedure must be carried out with gloves (to protect yourself from infection).

* - It is necessary to take into account the fact that when processing (soaking) a large number of instruments, especially if they are abundantly contaminated with blood or pus, the activity of the disinfectant solution decreases over time. But in this case, we are considering one survivor, and his daily turnover of instruments will be negligible in comparison with that of the regional hospital.

The washing up.

Now our tool is not infected. But there is still "dirt" on it in the form of tissue remnants and drugs. Now all this muck must be washed off. The tool is immersed in a special detergent (alkaline) solution containing detergent (washing powder), hydrogen peroxide and water *. Solution temperature 50-60 ° C, exposure 20 minutes. After that, the tools are washed with brushes in the same solution, and then in running water. These manipulations must also be carried out with gloves to protect yourself from aggressive chemicals.

Proportions:
Water- 978 ml.
Hydrogen peroxide (27.5%)- 17 ml. (!!! - It is such a high concentration that is made by diluting 33% perhydrol.)
Washing powder- 5 g.

Dry the instrument after washing. Drying can be done naturally. Recently, especially during subsequent sterilization with hot air, instruments are dried in a dry heat oven at 80 ° C for 30 minutes. After drying, the instruments are ready for sterilization.

Those disinfectants and detergents that I described were used in medicine until recently, and for us they have one advantage - they are more or less available. Modern medicine has many specially developed products that combine the properties of disinfectants and detergents. Thus, two separate stages merged into one, when the instrument is first immersed in a solution, sour disinfected there, and then in it and washed with a brush.

Sterilization.

So, our instrument is disinfected, clean and dry. Now he is ready for us to sterilize him. The methods of its implementation are different. There are many classifications, but I personally like to divide them into two types: hot and cold... The choice of the type of sterilization depends on the type of instrument or material. Do not forget that everything that comes into contact with the wound should be sterilized, and if you think that these are only tweezers and a scalpel, then you are deeply mistaken. This includes rubber gloves (once they were reusable), and dressings, and optical equipment (for laparoscopic operations). The hot method is easier to use, more reliable, but how do you imagine frying delicate optics or plastic / rubber?

In this regard, all instruments to be sterilized are conditionally divided into groups:
1. Metallic:
a) blunt (tweezers, clamps, needle holders ...);
b) piercing-cutting (needles, scalpels, scissors ...);
2. Containing plastic / rubber components.
3. Optics.

Only instruments belonging to category 1.a) can be hot sterilized without any consequences. Stabbing and cutting objects when exposed to high temperatures very quickly become blunt and become unusable. Although if there is no other way out, then they can also be heat treated. Also rubber gloves can withstand several hot sterilization cycles.

Hot sterilization methods:

Roasting and boiling

Firing is currently not used in the surgical clinic to sterilize instruments. The method can be used at home when it is impossible to use others. Firing metal tools is carried out with an open flame. Usually a tool is placed on a metal tray, a small amount of ethyl alcohol is poured and set on fire. [ the method of burning alcohol does not stand up to scrutiny and cannot be used for sterilization]

For a long time boiling was the main method of sterilizing instruments, but recently it is rarely used, since this method reaches a temperature of only 100 ° C, which is not enough to destroy spore-bearing bacteria.

The instruments are boiled in special electric sterilizers of various capacities. Opened instruments (disassembled syringes) are placed on a grid and immersed in distilled water (sodium bicarbonate may be added - up to a 2% solution).

Typical sterilization time is 30 minutes from boiling.

After the end of sterilization, the mesh with the instruments is taken out using special sterile handles.

Steam sterilization under pressure (autoclaving)

In an autoclave (apparatus for sterilizing with steam under pressure), water can be heated at an increased pressure. This raises the boiling point of water and, accordingly, the steam temperature to 132.9 ° C (at a pressure of 2 atmospheres).

Surgical instruments, dressings, linen and other materials are loaded into the autoclave in special metal boxes - Schimmelbusch bixes. Bix has side holes that open before sterilization. The lid of the bix is ​​tightly closed.

After loading the bixes, the autoclave is closed with a sealed lid and the necessary manipulations are performed to start its operation in a certain mode. The operation of the autoclave is controlled by indicators of a manometer and a thermometer.

There are three main modes of sterilization:
at a pressure of 1.1 atmospheres - 1 hour,
at a pressure of 1.5 atmospheres - 45 minutes,
at a pressure of 2 atmospheres - 30 minutes.

At the end of sterilization, the scraps remain for some time in the hot autoclave to dry with the door slightly ajar. When removing the bix from the autoclave, close the holes in the walls of the bix and mark the date of sterilization (usually on a piece of oilcloth attached to the bix). The closed box keeps the items in it sterile for 72 hours.

Hot air (dry heat) sterilization

The active agent in this sterilization method is heated air. Sterilization is carried out in special devices - dry heat sterilizers.

The instruments are placed on the shelves of the sterilizer cabinet and first dried for 30 minutes at a temperature of 80 ° C with the door ajar. Sterilization is carried out with the door closed for 1 hour at a temperature of 180 ° C. After that, when the sterilizer cabinet cools down to 50-70 ° C, the door is slightly opened and, upon final cooling, the chamber with sterile instruments is unloaded.

Sterilization in an autoclave and a dry heat cabinet is currently the main, most reliable way to sterilize surgical instruments.

In this regard, in hospitals, special central sterilization departments (CSO) are usually allocated, where these two methods are used to sterilize the most simple and frequently used instruments from all departments of the hospital (syringes, needles, simple surgical kits, probes, catheters, etc.) ...

Cold sterilization methods:

Radiation sterilization

Antimicrobial treatment can be carried out using ionizing radiation (gamma rays), ultraviolet rays and ultrasound. Sterilization with gamma rays is the most widely used in our time.

The isotopes Co60 and Cs137 are used. The dose of penetrating radiation should be very significant - up to 20-25 μGy, which requires compliance with particularly strict safety measures. In this regard, radiation sterilization is carried out in special rooms and is a factory sterilization method (it is not performed directly in hospitals).

Sterilization of instruments and other materials is carried out in sealed packages and, with the integrity of the latter, is preserved for up to 5 years. Hermetically sealed packaging makes storage and use of tools convenient (you just need to open the packaging). The method is beneficial for sterilizing simple disposable instruments (syringes, sutures, catheters, probes, blood transfusion systems, gloves, etc.) and is becoming more and more widespread. This is largely due to the fact that the properties of the sterilized objects are not lost at all during radiation sterilization.

Gas sterilization

Gas sterilization is carried out in special sealed chambers.

The sterilizing agent is usually: formalin vapor (formaldehyde tablets are placed on the bottom of the chamber [ paraform]) or ethylene oxide. Instruments placed on the grid are considered sterile after 6-48 hours (depending on the components of the gas mixture and the temperature in the chamber).

A distinctive feature of the method is its minimal negative impact on the quality of instruments, and therefore the method is used primarily for sterilization of optical, highly accurate and expensive instruments.

Unlike radiation sterilization, the method is used directly in hospitals.

Sterilization with antiseptic solutions

Sterilization with solutions of chemical antiseptics, as well as radiation and gas sterilization, refers to cold sterilization methods and does not lead to bluntness of instruments, and therefore it is used primarily for processing cutting surgical instruments.

For sterilization, three solutions are mainly used: triple solution *, 96 ° ethyl alcohol [ ethyl alcohol should be only 70 °, since it is this concentration that most effectively kills microorganisms] and 6% hydrogen peroxide. Recently, for cold sterilization of optical instruments, an alcohol solution of chlorhexidine, pervomur and others have begun to be used.

Triple solution:
carbolic acid- 3 g,
formalin- 20 g,
soda- 15 g,
water- 1000 ml.

For cold sterilization, the instruments are completely immersed unfolded (or disassembled) in one of the indicated solutions. When soaked in alcohol and a triple solution, instruments are considered sterile after 2-3 hours, in hydrogen peroxide - after 6 hours.

I think this method is the most optimal for use in the field.

Some of the information (in the form of finished text) was taken by me from this site. For those interested in surgery, I can recommend it. The information is well systematized, presented in an accessible form and not too specialized. About surgery in general terms.

Thank you for the attention.

Sterilization in surgery- used for disinfection of surgical linen, dressings, instruments and some devices used during operations and dressings.

Operating underwear (gowns, sheets, towels, masks) and dressings (gauze swabs, napkins and cotton wool) are sterilized with steam under pressure in an autoclave.

As an exception (in the absence of an autoclave), sterilization with flowing steam is used. In this case, steam, heated to t ° 100 °, passes through the bixes embedded in the apparatus and comes out. Such sterilization is unreliable, since not all bacteria are killed (spore-bearing bacteria die at t ° above 120 °). Linen and dressings are folded in a form that makes it easier to use and prevents unnecessary manipulations with it. The preparation of linen and material is carried out by a nurse wearing a gown, hat or kerchief. People with pustular diseases should not take part in this. The prepared material and linen are placed in Schimmelbusch metal drums (bixes), and robes, sheets, towels, large napkins and tampons are placed in large bixes, masks, small napkins, balls and cotton wool are placed in small ones. The placement of linen and material should be loose. Sheets, bathrobes, napkins, etc., should be placed in vertical rather than horizontal layers. In large operating rooms, stacking is done so that in each bix there is one type of linen or material. In small operating rooms, and especially for departures for an emergency operation, everything necessary for the production of one intervention is put into one bix, moreover, so that any item can be removed without touching all the others. A gown, a cap, a mask for the operating room nurse, who is the first to conduct personal aseptic training, is placed on top of all the contents.

When sterilizing in an autoclave, saturated water steam is used at 120–132 ° under a pressure of 1.5–2 atm. The bactericidal properties of steam are enhanced if air is removed from the material to be sterilized. However, this is complicated by the fact that the material is in bixes. In institutions with large autoclaves, the air is removed using vacuum pumps. In the absence of a pump, the air is removed by blowing - within 10 minutes. the sterilization chamber works like a fluid steam installation, that is, when the outlet valve is open, which is then closed. The sterilization time depends on the pressure and the quality of the material to be sterilized. The timing starts from the moment the required pressure and temperature are established. Simultaneously, bixes with a homogeneous material should be placed in the autoclave. When sterilizing bixes with dissimilar material, the time is set according to the material requiring a longer sterilization time. Before putting into the autoclave, all openings in the bix are opened. The autoclave should be loaded at the rate of 65-94 kg of linen or material per 1 m3 of the apparatus volume. Duration of sterilization of linen at a pressure of 2 am - 30 minutes, 1.5 am - 45 minutes; for dressing - at 2 am - 20 min., at 1.5 am - 30 min. At the end of sterilization, the autoclave is opened after 5-10 minutes. after removing steam (this is necessary to dry the material). When removing the bix, the holes in them are immediately closed.

Control over the sterility of the material is carried out at each sterilization by physical and chemical methods. The most reliable biological control. It should be used for periodic monitoring of sterilization, for example once a month, as well as in cases of suppuration after "clean" operations.

Sterilization of cans for hand washing is performed by burning. 10-15 ml of denatured alcohol is poured into a basin and set on fire. By rotating the pelvis in different planes, its entire inner surface is burned. The use of ether for these purposes is unacceptable due to the possibility of an explosion.

Catheters, tubes, drains are sterilized by boiling in distilled water for 30 minutes. Before boiling, new rubber products are washed with warm running water to remove talc. They can be stored in a solution that is used to sterilize gloves.

Conditions sterilization of rubber products in an autoclave are similar to those used for sterilizing gloves. Sterilization of surgical instruments is carried out by boiling, autoclaving and antiseptic agents. Non-cutting tools sterilized by boiling in 1-2% sodium bicarbonate solution, which prevents the oxidation of the metal and raises the boiling point. You can boil instruments in distilled water. The instruments, washed with a brush and soap and dried after the previous operation, are immersed in water on a grid in special metal vessels - sterilizers, the dimensions of which vary depending on the number and size of instruments. The boiling time of the instruments is 30 minutes. If the instruments were previously used during purulent surgery, and especially if they were contaminated with anaerobic microbes or Pseudomonas aeruginosa, the boiling time is increased to 45 minutes. or even they are boiled three times for 60 minutes. with water change. Before boiling, such instruments are immersed for several hours in a saturated solution of boric acid (if contaminated with Pseudomonas aeruginosa) or in a lysoform solution.

Boiling of instruments intended for "clean" and for purulent operations is carried out in separate sterilizers. Instruments can be sterilized in bixes or wrapped in sheets in an autoclave for 30 minutes. at a pressure of 2 am. Also used dry air sterilization in drying ovens at t ° 180-200 ° for 40 minutes. In emergency cases, sterilization of instruments by burning is allowed. Having laid them in a metal tray, they are poured over with alcohol, which is set on fire. But from such sterilization instruments deteriorate, and the method is not reliable.

Cutting tools when boiled in water they become blunt, therefore they are sterilized in a cold way. After washing with a brush and soap, they are immersed in 96% alcohol for 2 hours. Alcohol of lower concentration causes rust. You can use solutions of the following composition: carbolic acid - 3 parts, caustic soda - 15 parts, formalin - 20 parts, distilled water - 1000 parts; formalin - 20 parts, pure liquid phenol - 1.5 parts, sodium carbonate - 7.5 parts, distilled water - 500 parts. Sterilization in these solutions is less reliable, the formation of rust is possible, therefore, their use can be recommended only in the absence of alcohol. The exposure is the same as for alcohol sterilization.

Syringes sterilized by boiling in distilled water for 30 minutes. The cylinders and pistons are boiled separately, wrapped in gauze. If the syringes are made of heat-resistant glass that can withstand temperatures above 200 °, the best is dry-air sterilization at 200 ° for 30 minutes. The needles are boiled with mandrels or filled with water using a syringe. Otherwise, air remains in their lumen, which prevents the flow of water (air heated to t ° 100 ° does not ensure sterility). New needles are cleaned of grease and three times for 20 minutes. boil in a 2% sodium bicarbonate solution, changing the water each time. Then they are placed in gasoline for two hours and again boiled twice in a 2% sodium bicarbonate solution. Keep the needles dry with mandrels. Disassembled syringes and needles can be stored in 96% alcohol in special metal cases or in a glass vessel. Using the same syringe and needle for more than one person can lead to the transmission of epidemic hepatitis, even if the instruments are boiled before each injection. A reliable means of prevention is the centralized sterilization system, in which each syringe and needle, after a single use, is returned to the sterilization room for special treatment. The latter includes washing with a 10% solution of magnesium sulfate at t ° 45-50 ° (the needles are washed with a specially selected syringe) and immersion in the same solution for 15 minutes. This is followed by a thorough rinsing with distilled water, boiling in it for 5 minutes and only then sterilization - dry air or in an autoclave (each syringe with needles is in a separate package).

Sterilization of systems for intravenous fluid and blood transfusion and for intra-arterial blood injection, begin with the preparation of rubber tubes. They are washed with running water to remove talc and soaked for 6-8 hours. in a solution of sodium bicarbonate (bicarbonate of soda) - 100 g, ammonia - 50 ml, water - 10 liters. After repeated washing with running water, they are boiled in distilled water for 30 minutes. and dried. Glass parts - control glasses and droppers - are washed with hydrochloric acid or 10% solution of potassium dichromate in sulfuric acid and repeatedly with running water. The systems are mounted, placed in bixes or bags of dense cloth and sterilized in an autoclave for 30-40 minutes at 2 am. Rubber tubes should not be sterilized more than 3 times, as they lose their elasticity and strength. As an exception, systems can be sterilized by boiling in distilled water for 45 minutes.

Sterilization of anesthetic supplies- endotracheal tubes (rubber and plastic), removable inflatable cuffs and masks - carried out in a cold way. From boiling, they deteriorate, lose elasticity. Apply solutions of diiodide (diodide) mercury 1: 1000, aqueous-alcoholic solution of formaldehyde; aqueous-alcoholic solution of chloramphenicol 1: 1000 or one of the solutions used to sterilize cutting instruments. The solution is poured into a tall wide cylinder, closed with a lid with holes in the diameter of the tube. They are placed in a cylinder vertically so that a 1.5-2 cm segment protrudes from the outside through the holes. The tubes are kept in solution for at least 1 hour after thorough mechanical cleaning of them from mucus and pus. For this, the tubes are connected to a water tap and within 15-30 minutes. washed with a strong stream of water, and then wiped inside and out with a swab dipped in ether. The tubing can be sterilized in an autoclave within 30 minutes. at a pressure of 1.5 am. They are placed in a bix, the walls of which are covered with gauze or a towel. The inner surface of the masks and the blades of the laryngoscopes are washed with a 0.5% solution of ammonia and wiped several times with a napkin moistened with 96% alcohol. Metal parts - adapter tubes, forceps, dental spacers - are sterilized by boiling. Endoscopy devices are sterilized without optics by immersion in a solution of mercury oxycyanide 1: 2000 or mercury cyanide 1: 5000 for 6 hours. They are pre-washed with warm water and soap and, after drying, they are wiped with alcohol. The optical part is thoroughly wiped with alcohol and stored in a dry gauze cap. Ureteral catheters and elastic bougies, made of silk and impregnated with a special varnish, are sterilized with formalin vapor in a glass or metal container, at the bottom of which is a vessel with liquid formalin or formalin tablets. Metal bougies and catheters are sterilized by boiling. Dental instruments are sterilized by boiling or in a dry air chamber at t ° 120 ° for 30-40 minutes. Before sterilization, staplers are cleaned of vaseline oil, with which they are lubricated after use, collected, and charged. Sterilization is carried out by boiling in distilled water in an assembled and charged state. Along with the apparatus, charged spare magazines with tantalum staples are boiling. If there are cutting parts in the apparatus, they are sterilized separately according to the rules for sterilizing cutting instruments.

Sterilization of products made of synthetic materials: vascular prostheses made of lavsan, terylene, taflon, nylon and dacron, as well as nets of these materials - are produced by boiling in distilled water for 30 minutes. followed by immersion in alcohol for several minutes and rinsing with saline. Standard dentures are delivered sterile from the factory in special packaging.

Glass products are sterilized in an autoclave at a pressure of 2 am within 20 minutes. or by boiling in distilled water - 30 minutes, or in a dry air chamber at t ° 150-160 ° - 1 hour.
Preparation for sterilization of soft suture material (silk, catgut, nylon, lavsan, hair) and its sterilization are carried out in the operating room.
The Kocher method is used to process silk: silk is washed with soap in warm water, rinsed until the water is clear, and dried in a sterile towel. For this and subsequent manipulations, the nurse dresses as for an operation. The washed silk is wound on glass slides, spools or gauze rollers and subsequently immersed for degreasing in ether for 12-24 hours and in 70% alcohol for the same time. Then, after 10 minutes of boiling in a solution of mercuric chloride 1: 1000, the silk is placed for storage in 96% alcohol in jars with ground stoppers. Before the operation, the required amount of silk is boiled for 2 minutes. in a solution of mercuric chloride 1: 1000.
Modifications of the Kocher method are often used:

1. Bakulev's method: silk in skeins is washed in a 0.5% solution of ammonia, dried and immersed in ether for degreasing for 1 day. Sterilize the silk in an autoclave for 30 minutes. Store in 96% alcohol in sterile jars with ground stoppers.

2. After washing, winding on coils, defatting in ether and 70% alcohol and boiling in a solution of mercuric chloride 1: 1000 (No. 0-4 for 15 minutes, No. 5-8 for 30 minutes) silk is placed for 3 days in 96% alcohol, then produce it bacteriological examination (sowing) and pour 96% alcohol for storage.

3. The washed, wound on spools and defatted silk is sterilized in an autoclave for 15 minutes. under a pressure of 2 am and placed in 96% alcohol for 5 days. After seeding control, the silk is ready for use. Autoclaving reduces the strength of the silk. Every 10 days, the alcohol in which the silk is stored is changed, and the sterility of the silk is checked by sowing.

Nylon and lavsan threads are sterilized in an autoclave for 15 minutes. under a pressure of 2 am, placed in 96% alcohol for 5 days, then inoculated. Store in 96% alcohol. Sterilization is allowed by boiling in water (20 min.), And then in a solution of mercuric chloride 1: 1000 (5 min.), As well as by the methods proposed for silk sterilization. Nylon and lavsan threads can withstand any number of boils, including in mercuric chloride.

Paper and linen threads are sterilized like silk, or autoclavable together with dressings and linen.
Catgut requires more complex sterilization due to the fact that it is made from an extremely infected material - the intestines of sheep, and it does not tolerate boiling and autoclaving. Sterilization of catgut according to the Sitkovsky method: the catgut is defatted in ether for 12-24 hours, the threads are wiped with a tampon soaked in a solution of mercuric chloride 1: 1000, immersed in a 2% aqueous solution of potassium iodide (No. 0-1 for 30 sec., No. 2- 5 for 1 min., No. 6 for 2 min.), And then the catgut wound into rings is placed in a suspended state in a jar with a ground in and paraffin-filled cork at a distance of 6-7 cm from the bottom, where there is dry iodine (in a 3-liter can - 40 g, in a 5-liter can - 60 g). From time to time, the jars are slightly shaken for uniform access of iodine vapors to all skeins of catgut. Catgut is considered proternized № 0-1 - after 3 days, № 2-4 - after 4 days, № 5-6 - after 5 days and after sowing is placed in dry sterile jars with ground stoppers.

Claudius's method: for 14 days, catgut is kept in a solution: 1000 ml of distilled water, 10 g of pure iodine and 10 g of potassium iodide. Water can be replaced with formalin alcohol 1: 1000.
There are other modifications of the Claudius method: the catgut threads rolled into rings are defatted in ether for 1 day and placed in a solution of 1000 ml of pure alcohol, 10 g of iodine and 10 g of potassium iodide for 14 days, changing this solution after 7 days. Then produce bacteriological control and store in the same solution, changing it every 7-10 days. This is one of the most accepted methods in the USSR. Catgut can be sterilized in a solution of the following composition: 1000 ml of distilled water, 20 g of potassium iodide and 10 g of pure iodine. Rolled up in rings, catgut is placed in the solution twice for 8-10 days after keeping it for 12-24 hours. on air, and then for 4-6 days - in 96% alcohol. After bacteriological inoculation, catgut is stored in 96% alcohol, which is changed every 7-10 days.

Sterilization of instruments, including cutting instruments, is possible using ultrasound. The advantage of this method is that ultrasound also performs mechanical cleaning of instruments from blood and pus without damaging them. The instruments are placed in vessels with distilled water, and the emitter is lowered there. Ultrasound is used with a frequency of 800 kHz and a power of 20-30 W / cm. In 10 minutes. complete mechanical cleaning and sterility is achieved. Sterilization of linen, dressings, instruments, apparatus, solutions, etc. by gamma radiation is very effective. The dose of penetrating radiation should be at least 2,000,000 - 2,500,000 roentgens.

Sterilization of surgical instruments is carried out in two stages.

First step - pre-sterilization treatment, second- direct sterilization. The sequence of pre-sterilization preparation depends on the degree of bacterial contamination of the instruments.

Pre-sterilization preparation includes: disinfection, washing and drying. Due to the high risk of the spread of AIDS and the performance of operations in patients who have undergone hepatitis, the rules for pre-sterilization preparation have been changed and equated to the methods of processing instruments that provide a guarantee of the destruction of the human immunodeficiency virus. Instruments after purulent operations with anaerobic infection, patients who have undergone hepatitis over the last 5 years, as well as at risk of AIDS, are treated separately from others

Immediately after the operation, the instruments are immersed in disinfectants (3% chloramine solution for 40-60 minutes or 6% hydrogen peroxide solution for 90 minutes, 0.5% polydesis solution for 60 minutes, combined disinfectant of instruments for 60 minutes). After disinfection, the instruments are transferred to a washing solution (washing powder, hydrogen peroxide and water) at a temperature of 50 ° C for 20 minutes, then each instrument is washed with a brush disassembled and washed under running water. Currently, approved by the Ministry of Health of the Russian Federation in 1997, "Stages and modes of pre-sterilization processing of products from various materials" are used (Table 1).

Tab. 1.

Stages and modes of pre-sterilization cleaning of instruments, combined with disinfection with nnkrant 10A.

The quality of the pre-sterilization treatment is checked by setting azopyram, phenolphthalein and benzindine samples for the presence of residual detergent components, blood and fat. At least 1% of the batch of instruments that have been processed at the same time are subject to control. In addition, the quality control of pre-sterilization processing is carried out by the Center for Hygiene and Epidemiology once a quarter. If the sample is positive, the entire batch of instruments is subjected to repeated pre-sterilization processing.

The next step is to dry the instruments in a dry heat cabinet at a temperature of 80 ° C for 20 minutes.

The choice of sterilization method depends on the type of surgical instrument to be sterilized.

All general surgical instruments are conventionally divided into three groups:

Metal - cutting (scalpels, scissors, suture needles, amputation knives, etc.), non-cutting (syringes, injection needles, clamps, tweezers, hooks, probes, etc.);

Rubber and plastic (catheters, probes, drains, etc.);

Optical - laparoscopes, gastroscopes, choledochoscopes, cystoscopes, colonoscopes, bronchoscopes, etc.

Sterilization of surgical metal instruments and products from glass produced in the following ways.

Sterilization with dry hot air (aosterilization) is carried out in dry heat ovens (Fig. 3). Instruments and syringes

Fig. 3. Dry oven.

Disassembled items are placed in special metal nets or packed in kraft paper and sterilized at a temperature of 180-200 ° C for 1 hour. After sterilization, surgical instruments are transferred to an ultraviolet chamber to maintain sterility during their use (Fig. 4.). Products sterilized in kraft paper are kept sterile for 3 days.

Fig. 4. UFK 2.

For steam sterilization, the instruments are placed in Schimmelbusch bixes, loaded into autoclaves and sterilized at a pressure of 1.1 atm - 60 minutes, 1.5 atm - 45 minutes, 2 atm - 30 minutes. Shelf life in bix with filter - 3 days, without filter - 24 hours.

Disposable instruments are sterilized in sealed bags by ionizing radiation (y-rays), ultraviolet rays and ultrasound. Currently, y-ray sterilization is preferred. For these purposes, the isotopes Co and C are used. Sterilization must be carried out in compliance with safety measures in the factory. If the packages in which the y-rays were sterilized are kept hermetically, sterility is maintained for 5 years.

Boiling as a sterilization method is currently not used and refers to disinfection. Disinfection of instruments by boiling is carried out in electric sterilizers, different in design and capacity, on nets immersed in distilled water, with the addition of 2% sodium bicarbonate solution for 30 minutes. Sterilization of cutting and stabbing instruments is carried out at the factory using y-rays, a gas method and a cold chemical method using antiseptics. In dressing rooms, cutting and stabbing instruments are sterilized in dry heat ovens.

Chemical methods of sterilization include sterilization in sterilization chambers of an air sterilizer (one or two chambers) with a capacity of 80 dm 3 or more with formalin vapor. At the bottom of the chamber, formalin is placed at the rate of 10 g per 10 dm 5 of the chamber, the sterilization time is 16 hours. Instruments with an ebonite base, telescopes, all laparoscopic instruments, instruments with optics, especially precise and expensive instruments are sterilized by the chemical gas method. Before gas sterilization, laparoscopic instruments are disinfected in a 3% aldezone solution by rinsing in one container, then in the second container they are soaked for 1 hour and, after a time has elapsed, rinsed under running water from disinfectants.